Provider Demographics
NPI:1790020337
Name:JAFRI, FIRDAUS
Entity Type:Individual
Prefix:DR
First Name:FIRDAUS
Middle Name:
Last Name:JAFRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 N GARY AVE
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-1834
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:206 N GARY AVE
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-1834
Practice Address - Country:US
Practice Address - Phone:630-665-2147
Practice Address - Fax:630-665-6980
Is Sole Proprietor?:No
Enumeration Date:2012-12-09
Last Update Date:2012-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190194621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice